Seanad Éireann debate -
Wednesday, 23 May 2018

Vol. 258 No. 5

Bed Capacity at National Rehabilitation Hospital: Statements

Minister of State at the Department of Health (Deputy Finian McGrath)

I welcome the opportunity to make statements on the beds available at the National Rehabilitation Hospital. I thank Senator Victor Boyhan for raising this important issue. Since 2016, I have been tracking it closely and in regular contact with the Health Service Executive on it. I welcome Mr. John O'Donovan from the HSE.

The HSE has advised that the complexity of the medical conditions of patients referred to the National Rehabilitation Hospital for rehabilitation programmes has increased significantly in recent years, resulting in greater challenges for the hospital. In response, in late 2016, management at the hospital reduced its bed capacity by 12 to enable it to provide a safe and appropriate level of care for patients from within existing resources. Eight of the beds were in the brain injury programme and four in the spinal cord injury programme. Thankfully, the position at the hospital has improved since. In September and October 2017 funding was secured to reopen four of the closed beds. Two brain injury programme beds were reopened in September and in October another brain injury programme bed reopened, with one in the spinal cord system of care programme. In late December 2017 additional funding was secured to reopen a further two beds in the brain injury programme through the assistance of the Health Service Executive's national social care division as part of its winter planning strategy for the period 2017 to 2018. As things stand, a total of six beds have been reopened at the hospital, five of which are in the brain injury programme and one in the spinal cord system of care programme.

The Department of Health is working closely with the HSE to maximise potential capacity at the National Rehabilitation Hospital. As always, the first priority will be providing safe and appropriate services for patients. The hospital was not in a position to reopen additional beds in early 2018 owing to the ongoing risk of infection through multi-drug resistant organisms, MDROs. The hospital has eight single rooms which are appropriate for isolation purposes in the control of MDROs. It has been requested to forward a proposal to the HSE for increasing these facilities in the light of the increased challenges associated with the admission of patients with suspected MDRO infections. The HSE most recently met hospital management on 16 April and was advised that a submission to increase the number of single rooms, above the eight available, was nearing completion. The hospital also confirmed that a submission had been provided for the national hospitals office on the reopening of an additional six beds at the facility. The proposal is also being evaluated by the HSE's community health division. The HSE's operations and service improvement division has also sought to reopen the same beds through the winter planning process for the period 2018 to 2019. However, such considerations will only be concluded by October and November; therefore, if successful, the beds will be opened after this date. The Government recognises the excellent rehabilitation programme which the hospital delivers and its excellent patient outcomes.

On capital development, the current priority is the delivery of replacement accommodation at the National Rehabilitation Hospital. The redevelopment of the hospital which is under way and which I warmly welcome will be a major enhancement to rehabilitation services. It will have a direct and significant impact on patient recovery by providing an optimal ward and therapeutic environment for patient treatment. An investment of €64 million will ensure the existing ward accommodation at the hospital will be replaced by a new fit for purpose ward accommodation block of 120 single en suite rooms, with integrated therapy spaces, a new sports hall, a hydrotherapy unit, a temporary concourse, as well as clinical and ancillary spaces. In addition, links with the existing building will ensure full integration between the new development and the existing hospital on the site. The contracts for development works at the hospital were signed on 28 August 2017 and construction commenced on the site immediately. The construction of the hydrotherapy unit and the sports hall is expected to be completed by the end of the year, with the remainder of the construction works due for completion by the end of 2019 and expected to be operational in 2020. Phase 2 of the redevelopment of the National Rehabilitation Hospital involves the expansion of services to include all existing therapies and support facilities to the new hospital. Funding for phases 1 and 2 of this major redevelopment project is provided for in the national development plan 2018 to 2027. It is part of an overall €10.9 billion strategic investment in health services under the Project Ireland 2040 policy initiative.

I thank the House for giving me the opportunity to address these issues. I look forward to listening to the contributions of Senators.

Senator Victor Boyhan

I thank the Minister of State for coming to the House to discuss this issue which has taken up more of my time since I was elected to the Seanad than any other. I looked at the file again today. I wrote to the Taoiseach. I am sure the Minister of State has a copy of the correspondence because I understand the Taoiseach sent it to him. He certainly sent it to the Department of Health. I have taken up the matter with the Minister for Health, Deputy Simon Harris, and discussed it with the Minister of State and his officials.

I went on site at the opening of the extension and it is all good news. Let us cut the issue down to what it is. I know a substantial number of the staff at the National Rehabilitation Hospital. I lived next door to it for 20 years and know what is going on on a daily basis, despite what the Minister of State might hear or what his officials might tell him. I have spoken to the staff. Let us deal with some facts.

I am extremely disappointed with the response which is not necessarily from the Minister of State, but he is the person who communicated it. I will tell him why. In January 2017 the National Rehabilitation Hospital closed 12 beds. There is a substantial waiting list of inpatients and outpatients who wish to use the service. There are excellent services, wonderful clinicians and staff and a great board, with none of which I have a problem. After many promises, speeches, letters and telephone calls, six beds were eventually reopened. The most recent response I have received from the Department is dated 10 May and reads:

Morning Senator,

Minister McGrath sought an urgent update from the HSE on this matter as you requested. It appears there are no immediate plans to reopen the six beds in question due to staffing and resources constraints at the NRH. However, the NRH is actively seeking to have the beds reopened and has made a submission to the HSE in this regard. There may be scope for reopening beds through the winter planning programme of 2018-2019.

Frankly, that is not good enough. The Minister of State has special responsibility for people with disabilities. We know that a substantial number of people are trying to get into the hospital. Many are trying to leave it, but because appropriate transitional services are not available in the community, they cannot do so. I have some documentation from Senator John Dolan about one case which was highlighted in the media. I was in the hospital twice last week and patients were waiting for exit plans for rehabilitation services. There is a crisis. It is simply not good enough for a Minister of State to come to the House to say there may be six beds in 2018 or 2019.

I intend to raise the issue again next Tuesday and write to the Taoiseach today to say it is not good enough. If it means me running this as a major political issue to be discussed at public meetings in Dún Laoghaire, I intend to do so. I cannot understand why the six beds cannot be reopened. I am hearing different stories and ask the House to bear with me. It has been said there is a case to be made for looking at the issue and one will have to be made. The National Rehabilitation Hospital has confirmed to me that it has made a case to the HSE. What is the HSE doing about it? There can be nothing less than six beds reopened.

The Government will, as I have said since I entered the House, be judged on two things - health and housing. It is a poor show if we and the Minister of State cannot do everything in our power to have the beds reopened within one month. I am pleading with the Minister of State to make a very strong case to the Government. He is a key sustainer of it and has enormous power and influence. I ask him to use them to have the six beds reopened.

Senator Diarmuid Wilson

I welcome the Minister of State back to the House and congratulate my colleague, Senator Victor Boyhan, who has been raising this issue continuously in the past few years. That is why I gave way to allow him to lead off in this very important debate. I am speaking on behalf of my colleague, Senator Keith Swanick, who is unavoidably absent.

The Taoiseach recently turned the sod on a new development with 120 beds at the National Rehabilitation Hospital, but they are not additional beds. The plan is to provide 120 beds in two or three wings and knock down the existing building. There will be no increased capacity. I welcome the new development which will significantly improve facilities for staff and patients, but it will not address the ongoing capacity issues within the hospital, as Senator Victor Boyhan has continuously pointed out in the House.

The Government is underestimating the importance of this issue. Increased bed capacity at the National Rehabilitation Hospital is essential to support implementation of key Government policies, including the national neuro-rehabilitation strategy and the national trauma strategy. The British Society of Rehabilitation Medicine standards for specialist rehabilitation which are applied in Ireland indicate that a minimum of 60 beds per 1 million population for specialist inpatient rehabilitation medicine is required. In other words, 288 beds are required for the population of the country. This is in addition to the complex specialist rehabilitation tertiary service in the hospital which should provide for patients with complex rehabilitation needs such as a severe brain or spinal cord injury, low awareness states, challenging behaviour or concurrent complex medical needs.

In November 2017, 257 patients were on waiting lists for the National Rehabilitation Hospital. They are waiting anxiously for a coveted space in a hospital that they know is held in high regard and responsible for helping people the length and breath of the island. At an individual level, the impact of not receiving appropriate and timely rehabilitation services can lead to serious deterioration. At a system level, it can lead to increased hospital admissions and as a consequence delayed discharges. There is only one national rehabilitation hospital, in which the doctors and nurses are doing an excellent job in difficult circumstances. They need to be supported and provided with the necessary resources they require. The patients who need the services of the hospital need increased bed capacity. There is an argument to be made for providing a similar hospital in the south of the country, but that is for another day. I thank the Minister of State for his contribution and look forward to hearing his response.

Senator Colm Burke

I welcome the Minister of State. I fully accept that this is always a major challenge. My colleague is right about the need for long-term planning. The standard is 60 beds per 1 million population. Therefore, in real terms, we do not have a sufficient number of beds. About 20 years ago there was a proposal to develop a unit in Cork. We need to consider the long term. I agree with Senator Victor Boyhan on trying to fast-track the reopening of six beds. That is something we should try to sort out immediately. As part of Project 2040, it is proposed to build new hospitals. The programme needs to include the building of a second facility in the southern region to provide rehabilitation services for people who have suffered major injuries.

On Saturday I attended a function to raise funds for a person who had suffered a serious injury during the recent snow storm. He is in a rehabilitation facility in Dún Laoghaire and being looked after very well. A number of people from Cork attended the function. There are challenges for persons who want to visit family members in Dún Laoghaire. If we were to start planning now, it would be a number of years before things were up and running. We should start planning now and not wait until a new facility has been opened.

I welcome the new development. In fairness to the Government, it allocated money for the development of a new facility.

The best of facilities will be provided and that is long overdue. We must do a great deal more long-term planning in this area. It should be remembered that we have quite a number of people who are on the waiting list and who can make no progress. They are in hospital as it is and occupying beds which are needed by others on waiting lists. If we have insufficient numbers of beds in the rehabilitation unit, the speed of recovery is further delayed. It is important to do more long-term planning, but in the meantime we must prioritise this issue to ensure we have all of the beds which can be opened and funded. We must also ensure we have an adequate number of staff for those beds.

Senator John Dolan

I welcome the Minister of State and thank Senator Boyhan for his tenacity in this matter. The complexity of the medical conditions of the patients referred to has increased significantly in recent years. I do not, however, on the face of it accept complexity as a justification. Complexity is something which is growing all the time across our health services and hospitals. No one went home from work in the National Rehabilitation Hospital one evening and came in the following morning to find that the cases had become more complex. This is happening all the time. People are surviving traumas, whether strokes or other conditions, at a rate, thankfully, they did not before. A better explanation is therefore required. The issue of multi-drug resistant organisms is everywhere. Every hospital in the country is dealing with that, in particular those treating people with severe conditions. These explanations do not get to the nub of the issue.

If there are nearly 260 people waiting, as Senator Wilson said, to get into a hospital with capacity to treat just over 100, it means capacity is a massive issue. The simple, modest request being put to the Minister of State relates to when the six beds will be open. I should be giving out to Senator Boyhan for not talking about the other 100 plus beds which are needed but he is simply asking about half a dozen beds we were told would be opened. As to the capital development, while it will be fantastic that people will have a room of their own, more space and more dignity as part of their rehabilitation, it does not add a single bed to the outfit. I ask the Minister of State to confirm that for the avoidance of doubt.

It is a bit like airports. If airplanes cannot take off, one cannot work on capacity at the other end. One cannot have people coming in. A core problem is that people are in beds in the National Rehabilitation Hospital who should have been discharged. Senator Boyhan pointed out that I had been dealing recently with the case of a man in his early 30s who should have been discharged six months ago. That is half a bed per annum. He cannot move on because there is a bun fight among the HSE and some other institutions as to where he might go. Some of the places they suggest are tearing up the CRPD, to put it mildly. It is not about the man's progression and getting back on a pathway to independence. Housing, personal assistance, home supports and a bag of practical things, the content of which I need not lay out for the Minister of State, are a huge part of solving this issue. I ask the Minister of State to address that in his response.

Senator Niall Ó Donnghaile

I am acutely aware that there are Members who are much more familiar with the issues under discussion than me, but it is very important to take the opportunity to comment given the severity and passion involved and articulated previously. The National Rehabilitation Hospital provides complex specialist rehabilitation services to patients who, as a result of an accident, illness or injury have acquired a physical or cognitive disability and who require specialist medical attention. It provides comprehensive inpatient and outpatient services to adults and children. Backed by more than 50 years' experience, clinical expertise and a solid reputation for excellence, patients are given every opportunity to meet rehabilitation goals through personalised treatment plans delivered by interdisciplinary teams at the hospital. It is the only facility of its kind in the State and it operates according to an ethos of providing high-quality care and treatment to patients on the basis of clinical need. It is a registered charity and fundraises to deliver its much-needed services.

Brain trauma requires intensive and, in some cases, prolonged attention. To nurse severely damaged people back to full health, or as close to that as can be, adequate resources are required. We all know there is a general crisis in the health service. There is lower awareness, however, of the specific crisis at the rehabilitation hospital. The major concern for the hospital currently is bed capacity to cater for the increasing number of people in need of its special treatment. As I speak, there are 283 people on the waiting list. Last September, there were 236 people waiting for a bed. In nine months, nearly 50 people have joined the bed queue. What will the figure be in nine months? We do not know, but we can certainly speculate that it will increase. Currently, 19 children are awaiting a bed while 50 people are waiting for brain injury treatment. For these patients, it is an emergency situation. Given the size of the waiting list at the rehabilitation hospital, it is obvious the Government's policies are failing people in distress.

I have a number of questions for the Minister of State. While some have been asked, they are worth repeating. What practical steps are being taken to reduce the waiting list? Does the Government intend to recruit extra staff? Will the Minister of State listen to front-line staff, including the doctors, nurses and other health care professionals whose exceptional dedication absorbs so much of the hidden pressure caused by underfunding? It is clear that additional tailored funding is required for the rehabilitation hospital. How many empty beds are there in the hospital? A new rehabilitation hospital is due to open in 2020. Even before its doors open, there are worrying signs of bed capacity issues. Its bed capacity of 120 is similar to what is available in the current hospital. While a new hospital is necessary and welcome, we have no new ideas from Government as to how to bring an end to waiting lists. What does the Government intend to do with the current hospital? Will it continue as a rehabilitation hospital to provide extra beds?

The impact of the current circumstances on the rehabilitation of people is very worrying. The Neurological Alliance of Ireland is running a campaign, entitled We Need Our Heads Examined, which calls for investment in rehabilitation services for people with neurological problems. I urge the Minister of State to examine his head and to listen to those who know what needs to be done to ensure the crisis in the rehabilitation hospital is resolved to the satisfaction of those who are in the greatest need, namely, those on the waiting list.

Senator Frank Feighan

The National Rehabilitation Hospital in Dún Laoghaire is in major need of redevelopment. There have been extensive discussions over many years on the building of a new hospital on the site. Unfortunately, the economic downturns of the 1980s and 2008 have prevented the project getting off the ground. In the intervening years, the waiting list at the National Rehabilitation Hospital has grown longer. We are talking here about patients with spinal and brain injuries who are waiting for life-changing treatments. What is making the situation worse is the fact that the hospital is not operating at full capacity due to 12 bed closures earlier this year. It is an unacceptable situation which must be resolved as a matter of urgency.

On a more positive note, I am glad to see the wheels have started to turn on the new hospital earmarked for the site. Last October, the Taoiseach, Deputy Varadkar, and the Minister for Health, Deputy Harris, turned the sod to mark the commencement of phase 1 of the new hospital development. As people have said, phase 1 includes the provision of 120 new single-bed-en suite rooms while phase 2 will provide for the relocation of all existing therapies and support facilities to a new, modern development to serve the new 120-bed hospital. Phase 3 will include the completion of a 235-bed hospital. While there is a great deal of work to be done, the sooner the project can move to phase 3, the better it will be for all concerned.

I am very encouraged also by the major progress on an €8 million medical rehabilitation unit at Roscommon University Hospital. It is a capital project on which I have strongly campaigned and delivered over recent years. We must remember that the National Rehabilitation Hospital in Dún Laoghaire is the only comprehensive rehabilitation facility in the Republic of Ireland for patients with physical and cognitive impairments.

When the stand-alone rehabilitation unit at Roscommon University Hospital is built, it will relieve pressure on existing services and waiting times at the National Rehabilitation Hospital, NRH, in Dún Laoghaire and allow patients to be treated in their communities. The ten-bed unit in Roscommon will operate as a satellite centre of the National Rehabilitation Hospital and under its auspices. From a geographical perspective, Roscommon hospital's central location is ideal for this development as it is accessible from the west and Dublin. The development will create 25 jobs initially and up to 50 jobs when all phases are complete. I am pleased to note the project is at design stage and I look forward to its completion in the not too distant future. We hear a great deal about decentralisation. The new rehabilitation unit will be an important facility for the west and it cannot come soon enough for both Dún Laoghaire and Roscommon.

An Leas-Chathaoirleach

I ask Senator Devine to make it snappy because I must call the Minister of State before 4.30 p.m.

Senator Máire Devine

I add my voice to those calling for the reopening of six closed beds in the National Rehabilitation Hospital and commend the passion of Senator Boyhan. He could be the NRH mascot and he is certainly its champion given the number of times he has raised the issue in the House.

The future plans and strategy for the hospital are fantastic. It often strikes me, however, that we under-plan for every single service in health, although housing also comes to mind. We should be capable of deciding that a service providing 100 beds will require, for example, 200 beds in ten years. Modern treatments make it much more likely that many more beds will be needed in future as most people will be able to survive life-threatening illnesses.

Some years ago, a friend of mine who is a nurse had a stroke at 39 years of age. She was in Navan hospital and we pressed to have her provided with rehabilitation services, believing the hospital might listen because she was a nurse. In the case of stroke it is necessary to have damage caused to the brain treated in the first few weeks. There was no room in the National Rehabilitation Hospital for my friend, however, and I am sure many Senators have had similar experiences. Many people are being left with lives unlived and opportunities missed as they are forced to remain in hospital, nursing homes and other inappropriate care settings. This issue, which has been discussed previously in the House, calls into question whether the rights of the disabled are being vindicated and impact on the Assisted Decision-Making (Capacity) Act.

We repeatedly fail to plan for the future. If Senator Boyhan or I could find staff today, would the Minister of State be able to issue a cheque to open the six closed beds in the National Rehabilitation Hospital?

Senator Maura Hopkins

I thank the Minister of State for coming to the House. Senator Boyhan and I were among the first public representatives to raise the issue of 12 beds being closed in the National Rehabilitation Hospital last year. It is deeply frustrating that while half of the beds have been opened, six remain closed. That is not good enough. We hear a great deal about capital development, which is positive, but the most important aspect of delivering rehabilitation is to ensure adequate staffing is available and the service provided by the NRH is able to operate to capacity.

The National Rehabilitation Hospital has confirmed that a submission has been made to the National Hospitals Office regarding the reopening of six beds at the facility. We understand, however, that the outcome of these considerations will not be available until October or November. Based on today's debate, I ask the Minister of State to escalate this very serious issue. The National Rehabilitation Hospital is the national service for people with brain injury, stroke and spinal cord injury who need access to timely specialist rehabilitation.

Based on information provided by the NRH yesterday, there are nine delayed discharges in the hospital. This refers to people who may need adaptations or home supports. Delayed discharges affect the hospital's ability to admit new patients and compound the problems caused by the failure to open six beds in the hospital. We have been here before and there has been little improvement in the meantime. The six closed beds at the NRH must be reopened without delay. I ask the Minister of State to seek an update on this matter from the Health Service Executive and to revert to the Seanad with the response because the current position is simply not good enough.

It is positive that progress is being made in developing a rehabilitation unit at Roscommon University Hospital. I understand a design team is in place. It is essential that the project progresses to planning and is delivered as quickly as possible because it is needed to cater for the many people who require rehabilitation support.

An Leas-Chathaoirleach

I am sorry Senators needed more time. I must also apologise to the Minister of State because the order of the day provides that he must conclude in four minutes at 4.30 p.m.

Minister of State at the Department of Health (Deputy Finian McGrath)

I thank Senators Boyhan, Wilson, Colm Burke, Dolan, Ó Donnghaile, Feighan, Devine and Hopkins for their valuable contributions. It is clear from this debate that all of us agree that the work of the National Rehabilitation Hospital is critical to the care of people who require its services. Neurological illness or injury has significant implications for individuals and their families and impacts on social, educational, vocational and recreational participation.

I accept that all those who spoke understand the issue. Senators raised valuable points on exit plans, the investment of €64 million, bed capacity, long-term planning and the urgent need for a second facility. It is also important that sufficient beds become available in the rehabilitation unit.

Senator Dolan referred to personal assistance and housing, an issue on which I am working closely with the Minister for Housing, Planning and Local Government, Deputy Eoghan Murphy. Senator Ó Donnghaile raised the issue of waiting lists while Senator Devine raised the issue of under-planning. I will take the points they made on board.

Senator Hopkins spoke of delays and noted the importance of the new facility in Roscommon. I recognise all the important points made in this debate and I give a commitment to convey them to the Minister for Health, Deputy Harris. I will also press for progress on the issue personally.

The National Rehabilitation Hospital provides complex specialist rehabilitation services to patients who, as a result of an accident, illness or injury, have acquired physical or cognitive disability and require specialist medical rehabilitation. The hospital has a reputation for excellence and provides patients with every opportunity to meet rehabilitation goals through personalised treatment plans delivered by consultant-led teams whose members are experts in their fields. The rehabilitation programmes at the hospital are tailored to meet the individual needs of adult and paediatric patients in the following areas of specialty: brain injury; spinal cord system of care; prosthetic, orthotic and limb absence rehabilitation; and paediatric family-centred rehabilitation.

I emphasise again the Government's commitment to the area of neurorehabilitation, and the development of the new 120 bed National Rehabilitation Hospital on the existing campus is a priority. I have been pressing for this development. The design is inpatient centred and based on the principles of empowerment, dignity, privacy, confidentiality and choice. There will be a major enhancement of rehabilitation services which will have a direct and significant impact on patient recovery by providing the optimal ward and therapeutic environment for patient treatment at the hospital.

The model of care proposed in the strategy is a three-tiered model of specialist rehabilitation services and complex specialist tertiary services, specialist inpatient rehabilitation units and community-based specialist neuro-rehabilitation teams. These kinds of actions are starting as I speak.

As a first step, a managed clinical rehabilitation network project is in development to establish collaborative care pathways for people with complex neuro-rehabilitation care and support needs, accommodation needs, or both. We have to deal with accommodation needs if we are to assist the nine people who are occupying beds but want to exit these services. The National Rehabilitation Hospital will participate in the demonstration project.

I thank Senators for their valuable contributions to this important debate. I am listening to the points they are making. I am conscious that we have people in these circumstances. All of the issues that are being raised will be brought back to the Minister for Health, to the Department of Health and to the HSE.